Stethoscope and $5 bills
Stethoscope and $5 bills - 
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Tess Vigeland: Take everything this country spends on health care -- the government, employers, patients -- and it rounds out to a little over $8,000 per person on average.

But averages don't really tell the whole story. A study by the National Institute for Healthcare Management found that in 2009, 15 percent of us had no health care costs at all. While at the other end, 5 percent accounted for almost half of all health care costs: $1.2 trillion.

Just who are all these big spenders? From our health care desk at WHYY in Philadelphia, Gregory Warner tries to put a face on them.

Gregory Warner: Maybe you picture this high-cost patient as someone at the end of life, confined to a hospital bed and hooked up to expensive medical devices. But more likely, you'll find this person at home or in a nursing home, living with five or more chronic conditions.

Tom Bodenheimer: Hypertension, diabetes, arthritis, cognitive impairment, heart failure and chronic obstructive pulmonary disease. That's six right there!

Tom Bodenheimer is a professor of medicine at UC San Francisco. He says the costliest patients are typically elderly, poor and have trouble taking care of themselves.

Lisa Alecxih is with the Lewin Group, part of United Health Care.

Lisa Alecxih: Well if you can't take a bath by yourself. If you are unable to get dressed on your own. Or you can't do your own shopping.

Having a functional limitation makes you almost seven times more likely to be one of the high spenders, because if you can't manage your illnesses, you end up going back and forth to the emergency room.

Bob Hoban is chief strategy officer for St. John Providence, one of Detroit's larger hospitals; it employs 17,000 workers. Hoban dealt with his own health care costs by arranging for some of his employees -- the nurses -- to nag other employees, the ones with the chronic conditions.

Bob Hoban: To work with that individual to help them lead a healthier lifestyle. Are they exercising regularly? Are they following their doctors' orders on a regular basis?

Fewer than 1 percent of employees signed up to be pestered this way. But the program worked. The hospital saved $8 million over four years by cutting costs for its highest spenders. Now Hoban says St. John Providence is marketing the program and taking it national.

In Philadelphia, I'm Gregory Warner for Marketplace.

Follow Gregory Warner at @radiogrego